 |
 |
 |
 |
 |
 |
 |
 |
 |
Help Suzanne Aucoin
Jan. 31, 2007 - The Star
Ontario to pay $76,000 drug bill TheStar.com - News - Ontario to pay $76,000 drug bill
Bittersweet victory over bureaucracy: `I should never have had to deal with this'
January 31, 2007
Rob Ferguson
Queen's Park Bureau
She's fighting colon cancer but Suzanne Aucoin is elated after a rare personal apology
from Ontario's health ministry, which admitted it was wrong in refusing to pay for her
chemotherapy in Buffalo and is reimbursing her every penny.
A cheque for $76,018.23 was expected to arrive at her St. Catharines home today
following an investigation by Ontario Ombudsman André Marin, who said the rules for
seeking out-of-country treatment are so complex "it's like handing patients a Rubik's
cube."
Marin persuaded bureaucrats to change their minds about Aucoin's case – and their
policy for others in her situation, with clearer guidelines to be issued along with
better explanations when requests for any form of out-of-country treatment are
denied.
Aucoin said she's glad the victory will have an impact beyond her own case but it
remains bittersweet after more than a year of appeals to bureaucrats and Ontario
Health Insurance Plan review boards.
"I should never have had to deal with this, it takes all my energy to fight cancer," the
36-year-old teacher on medical leave told the Toronto Star last night before heading
out for a celebratory dinner.
"It rights a wrong on some levels but you cannot put a price tag on my mental strain
and stress."
The money will cover her $57,000 bill for drugs with the remainder going to her legal
fees for Toronto lawyer Brian Cohen, who called the decision "marvellous" proof that
patients can fight the system.
Aucoin's colon cancer has spread to the liver, lungs and lymph nodes and she remains
under treatment with the drug Erbitux, which she had to obtain first in Buffalo and
later in Hamilton at her own expense after OHIP rejected her application for funding
two years ago.
Bureaucrats first ruled the Erbitux and other drugs for which she applied were
experimental and not eligible, although her own doctor recommended them as the
best course of treatment and other Canadians were being sent to Buffalo for Erbitux
at the time. So she arranged to get them at a private clinic in a Buffalo suburb at
about half the cost of the better-known Roswell Park Cancer Institute where the
province sends patients.
A subsequent appeal for coverage was rejected last November because the private
clinic – run by a licensed cancer specialist also on staff at Buffalo's Mercy Hospital –
was itself not licensed, as required by provincial guidelines to protect taxpayers from
funding treatment at dubious clinics.
This was despite the fact that the appeal board found "no indication" the private clinic
was not reputable and testimony that New York state or local law does not require
such facilities to be licensed.
Marin's office had been following Aucoin's case but could not get involved until the
official appeals were exhausted two months ago.
"We were shaking our heads from Day 1," Marin said. "They were fighting her every
step of the way. It's an absolute calamity what happened to her."
Health Minister George Smitherman said in a statement last night that Marin's
investigation prompted officials to review the out-of-country health coverage program
to make it "work better for Ontario patients," including immediate steps to provide
doctors with more information.
There is a need for "greater information about funding for particular treatments, to
ensure that decisions about funding for out-of-country treatment are consistent and
based on evidence, and to improve the quality of reasons provided when requests are
denied," the statement continued.
Out-of-country treatments can be authorized when the care is not experimental, is
not available in Ontario, and when delay "would result in death or medically significant
irreversible tissue damage."
In Aucoin's case, the major problems included "unintelligible" form letters she received
rejecting her applications, said Marin.
"They need to stop doing form letters, they need to be more in tune with the public
they serve," he added.
The apology to Aucoin came in the form of a phone call to her home yesterday
afternoon by deputy health minister Ron Sapsford. "He just sort of said ... `I realize
you've had a difficult time,'" Aucoin recalled. "I accepted it, I thanked him for it."
Ontario to pay $76,000 drug bill TheStar.com - News - Ontario to pay $76,000 drug bill
Bittersweet victory over bureaucracy: `I should never have had to deal with this'
January 31, 2007
Rob Ferguson
Queen's Park Bureau
She's fighting colon cancer but Suzanne Aucoin is elated after a rare personal apology
from Ontario's health ministry, which admitted it was wrong in refusing to pay for her
chemotherapy in Buffalo and is reimbursing her every penny.
A cheque for $76,018.23 was expected to arrive at her St. Catharines home today
following an investigation by Ontario Ombudsman André Marin, who said the rules for
seeking out-of-country treatment are so complex "it's like handing patients a Rubik's
cube."
Marin persuaded bureaucrats to change their minds about Aucoin's case – and their
policy for others in her situation, with clearer guidelines to be issued along with
better explanations when requests for any form of out-of-country treatment are
denied.
Aucoin said she's glad the victory will have an impact beyond her own case but it
remains bittersweet after more than a year of appeals to bureaucrats and Ontario
Health Insurance Plan review boards.
"I should never have had to deal with this, it takes all my energy to fight cancer," the
36-year-old teacher on medical leave told the Toronto Star last night before heading
out for a celebratory dinner.
"It rights a wrong on some levels but you cannot put a price tag on my mental strain
and stress."
The money will cover her $57,000 bill for drugs with the remainder going to her legal
fees for Toronto lawyer Brian Cohen, who called the decision "marvellous" proof that
patients can fight the system.
Aucoin's colon cancer has spread to the liver, lungs and lymph nodes and she remains
under treatment with the drug Erbitux, which she had to obtain first in Buffalo and
later in Hamilton at her own expense after OHIP rejected her application for funding
two years ago.
Bureaucrats first ruled the Erbitux and other drugs for which she applied were
experimental and not eligible, although her own doctor recommended them as the
best course of treatment and other Canadians were being sent to Buffalo for Erbitux
at the time. So she arranged to get them at a private clinic in a Buffalo suburb at
about half the cost of the better-known Roswell Park Cancer Institute where the
province sends patients.
A subsequent appeal for coverage was rejected last November because the private
clinic – run by a licensed cancer specialist also on staff at Buffalo's Mercy Hospital –
was itself not licensed, as required by provincial guidelines to protect taxpayers from
funding treatment at dubious clinics.
This was despite the fact that the appeal board found "no indication" the private clinic
was not reputable and testimony that New York state or local law does not require
such facilities to be licensed.
Marin's office had been following Aucoin's case but could not get involved until the
official appeals were exhausted two months ago.
"We were shaking our heads from Day 1," Marin said. "They were fighting her every
step of the way. It's an absolute calamity what happened to her."
Health Minister George Smitherman said in a statement last night that Marin's
investigation prompted officials to review the out-of-country health coverage program
to make it "work better for Ontario patients," including immediate steps to provide
doctors with more information.
There is a need for "greater information about funding for particular treatments, to
ensure that decisions about funding for out-of-country treatment are consistent and
based on evidence, and to improve the quality of reasons provided when requests are
denied," the statement continued.
Out-of-country treatments can be authorized when the care is not experimental, is
not available in Ontario, and when delay "would result in death or medically significant
irreversible tissue damage."
In Aucoin's case, the major problems included "unintelligible" form letters she received
rejecting her applications, said Marin.
"They need to stop doing form letters, they need to be more in tune with the public
they serve," he added.
The apology to Aucoin came in the form of a phone call to her home yesterday
afternoon by deputy health minister Ron Sapsford. "He just sort of said ... `I realize
you've had a difficult time,'" Aucoin recalled. "I accepted it, I thanked him for it."